(A) Cyanosis

If this is due to excessive secretion or the falling back of the tongue or jaw, or falling of the paralyzed epiglottis so as to act as a valve over the glottis, or turning of the head too much to the side, the condition should be promptly remedied. If there is respiratory weakness, the anesthetic should be stopped and a respiratory stimulant, such as caffeine or atropine, injected hypodermatically. In the laboratory a dog lightly anesthetized with ether or chloroform is likely to become conscious and recover his reflexes if a hypodermic of caffeine is administered. If necessary, artificial respiration or pharyngeal insufflation, and the administration of oxygen may be resorted to.

(B) A rapid, weak, or irregular pulse suggests the withdrawal of the anesthetic and the use of saline by rectum or intravenously.

(C) For marked collapse, the following is the treatment:

1. If from ether, lower head, raise feet, and give free access of air. If from chloroform, keep body level, or may precipitate heart failure (Bennett).

2. Keep up body warmth, using hot towels and hot blankets.

3. Inject hypodermatically atropine, caffeine, or camphor (not ether or whisky). Camphor may be useful in chloroform collapse, where the heart is the organ at chief fault. (See discussion under Camphor.)

4. If an ether case, give hot saline by rectum; or a slow intravenous infusion of about 500 c.c. of normal saline solution, to which may be added 15 minims (1 c.c.) of epinephrine hydrochloride solution or 15 minims (1 c.c.) of pituitary liquid. In chloroform anesthesia Levy and Lewis found epinephrine contra-indicated; yet we have surgical reports of excellent results from adrenaline even after chloroform.

5. If necessary, the limbs may be bandaged from fingers and toes up, or Crile's pneumatic suit applied, or pressure made upon the abdomen with weights or bandages.

6. Artificial respiration and the administration of oxygen and carbon dioxide. Henderson says that carbon dioxide should not be given in concentration above 6 per cent. Meltzer's method of artificial respiration by intratracheal insufflation or by a suitable mouth-cap may be employed.

7. If the heart stops, try rhythmic thumping or pressure over the heart, or rhythmic pressure at a rate of 30 per minute in the epigastrium; in an abdominal operation massage heart through the diaphragm. If the heart has ceased to beat, inject 10 minims of adrenaline solution and 10 minims of the tincture of digitalis into the cavity of the ventricle or beneath the pericardium, and massage vigorously. The author has resuscitated dogs in this manner.

Ether, whisky, and strychnine hypodermatically have repeatedly been shown to increase the collapse, and electricity to produce fibrillation and stoppage of a weak heart. In chloroform collapse the heart is very feeble, so that measures to increase the peripheral resistance must be instituted with caution; and Bennett says, "do not lower the head end of the body."

Therapeutics

The objects of general anesthesia are: to abolish pain, to abolish consciousness, and to relax muscle. General anesthesia may be employed:

1. In surgical cutting operations.

2. To set a fracture.

3. To reduce a dislocation.

4. To reduce a hernia.

5. To permit more thorough examination for diagnosis of the abdomen or an injured limb.

6. To stop convulsions (tetanus, strychnine poisoning).

7. In labor - at the time of the expulsion of the fetal head to stop pain (perineal pain) and lessen or abolish the contractions of the uterus. As a rule, only enough chloroform is required for this to wet well the chloroform mask. General anesthetics tend to lessen the power of the uterus to contract, hence to some extent favor postpartum hemorrhage. Postpartum operations are preferably done under ether.